Medication guide

Eszopiclone (Lunesta)

What is eszopiclone?

Eszopiclone is known as Lunesta in the United States and Japan alike (ルネスタ on Japanese packaging); in the UK, the closely related zopiclone (Zimovane) is used instead. It belongs to the "Z-drug" (non-benzodiazepine) group of sleep medicines: it calms the brain's activity at night to help you fall asleep and stay asleep, and it's meant as short-term help while sleep settles.

How is it different from other sleeping pills?

Works from the first night, on both falling asleep and staying asleep
Not a controlled substance in Japan, which is unusual for a sleeping pill of its type: simpler prescribing rules, and ordinary import rules when travelling
A little longer-acting than zolpidem, which helps when waking during the night is the problem
Decades of worldwide familiarity as Lunesta

What is it used for in Japan?

Insomnia: both falling asleep and staying asleep.

What it targets: more of the night than zolpidem, thanks to its slightly longer action; a fit when waking during the night is part of the problem.

How does it help?

It quietens the brain's activity at night so you can fall asleep more easily and stay asleep longer. It works the same night, taken just before bed, and it works best as a short bridge alongside good sleep habits.

What should I tell my doctor before starting?

A few situations rule it out entirely; your doctor will choose something else if any of these apply:

A past allergic reaction to eszopiclone or zopiclone
Myasthenia gravis (a muscle-weakness condition)
Acute narrow-angle glaucoma

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

Serious liver or kidney problems (a lower dose is used)
Other sedating medicines, or regular alcohol use
Breathing problems during sleep (such as sleep apnea)
Being older: a lower dose is usual
Pregnant, planning to be, or breastfeeding (see the section below)

How do I take it?

Only right before bed, and only on nights you can give a full night to sleep.

Take it immediately before lying down; avoid taking it with or just after a meal, which weakens the effect
Don't take it if you might need to get up and function during the night
If you forget it, just skip that night. Never take a second dose in one night
Go easy on alcohol; it adds to the effect

What side effects should I expect?

Most are mild. Not everyone gets them.

A bitter or metallic taste (the most commonly noticed effect, in roughly a third of people): harmless, often noticed the next morning, and it fades after stopping
Drowsiness, or grogginess the next morning
Headache
Dizziness
Dry mouth

If anything is bothering you, tell your doctor; there's often a way to adjust.

Finally, one thing that is rare (most people never experience it) but good to know:

Very occasionally, people carry out activities while not fully awake (walking, eating, even driving) with no memory of it afterwards. If you or someone around you notices this, stop the medicine and tell us; switching to a different type of sleep aid solves it

Will I become dependent? How do I stop safely?

It can be habit-forming with regular long-term use, so it's used short term, at the lowest dose that works, and stopped with a plan. The body can come to rely on Z-drugs, and stopping suddenly can bring a few nights of rebound poor sleep, so never stop suddenly on your own; your doctor lowers it gradually or shifts to as-needed use. The aim is a short bridge while sleep recovers, not an indefinite prescription.

Can I drive while taking it?

No. Don't drive after taking it, and be alert to leftover drowsiness the next morning. Like other sleep medicines, the Japanese label instructs that patients on eszopiclone shouldn't drive or operate dangerous machinery. If next-morning sleepiness keeps happening, tell your doctor; the dose or the medicine can be changed.

What about pregnancy and breastfeeding?

Tell your doctor early; this one is planned case by case. In pregnancy, sleep medicines are kept to the minimum and other approaches are often preferred first. With breastfeeding, eszopiclone is generally avoided. Don't start, stop, or continue on your own; our guides to medication in pregnancy and medication while breastfeeding cover the wider picture.